A flowering plant, marijuana has for centuries been produced for its plant fiber, hemp. Because of its strength and endurance, hemp is widely used to make ropes and other fibrous products. Evidence of the existence of marijuana, or Cannabis sativa, can be found in prehistoric archaeological sites in Euro-Asia and Africa.1 The oldest known written description of cannabis use is by the Greek historian Herodotus, who wrote more than 400 years BC about Eurasian Scythians using cannabis in steam baths.1,2

Background

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Marijuana is the most commonly used illegal drug in the United States.3 Recently, there has been a push for legalization of marijuana because many people now feel that the overall effects of the drug are harmless. Marijuana for recreational use is legal in 4 states, with an additional 19 states approving it for medicinal use.3 Regardless of whether marijuana is legal in individual states, it is still illegal under federal law.

Science

The first and most studied medical use of C sativa is in the control of nausea and vomiting caused by chemotherapy.4 For these patients, the antiemetic action is desirable, and the increased appetite resulting from marijuana use is also beneficial, as most patients need to increase food intake.4 Marijuana is also useful for those with wasting diseases such as acquired immune deficiency syndrome (AIDS).4

The component of C sativa that produces the euphoric feeling is tetrahydrocannabinol (THC).5 The mechanism of action that produces euphoria and relaxation is distributed among several receptors in the central nervous system, collectively recognized as the endocannabinoid system.6 When inhaled, THC is absorbed rapidly into the system, peaking within minutes. Marijuana is known to cross the blood-brain barrier and the placenta, but it is accumulated in fat cells.

Some very small studies have indicated that THC is useful in lowering intraocular pressure in those with glaucoma. Although there have been findings that THC lowers intraocular pressure, the effect is short-term and nonspecific, indicating that low blood pressure and other central nervous system depressive responses also occur.7 In one study, 9 patients with refractory glaucoma were given THC by either smoking or oral tablet.7 At the end of 9 months, all patients had discontinued the study because of the side effects of THC. A rapid tolerance to THC’s pressure-reducing action was also noted.

Other areas of potential medical use of THC include the relief of spasticity in neurodegenerative diseases, for pain reduction, and for seizure control, but there have been few trials of adequate design and significance to recommend THC for these conditions. However, there are many anecdotal descriptions of successful treatment with THC in individuals. In 2014, the directors of the Epilepsy Foundation called for much more lenient policies to allow patients to access marijuana in cases where traditional therapy was either not tolerated or ineffective.8

Safety, interactions

It is unclear whether marijuana is addictive or leads to hard drug use. The impact of THC on an individual varies according to a multitude of circumstances, including age, frequency of use, concomitant substance use, and medication intake.

Because of the known changes in visual and motor coordination following recent THC inhalation, researchers are in the process of developing a marijuana breathalyzer.9 Much like alcohol, exhaled levels of THC dissipate rapidly (0.5-2 hours), which may be a significantly limiting factor in the accuracy of the device.

How supplied, dose, cost 

Dronabinol, a synthetic delta-9-tetrahydrocannabinol approved by the US Food and Drug Administration (FDA), is taken at 2.5 to 20 mg/day in divided doses and titrated slowly based on individual tolerance and effect.10 This form of medical-grade THC costs an average of $2 per pill, with a typical prescription costing up to $800.11 The cost of non-FDA-approved medical marijuana is up to $400 per ounce, not including any smoking or inhalation paraphernalia.12

Summary

Regardless of the legal status of marijuana and its derivatives, there is insufficient evidence to recommend medical marijuana to patients. FDA-approved dronabinol may be recommended in certain cases.

References

  1. Butrica JL. The medical use of cannabis among the Greeks and Romans. Journal of Cannabis Therapeutics. 2002;2(2):51-68.
  2. Rawlinson G, trans-ed. The History of Herodotus. The Internet Classics Archive website. http://classics.mit.edu/Herodotus/history.html
  3. Lee J. Which states have legalized marijuana? USA Today. http://www.usatoday.com/story/news/nation-now/2014/01/06/marijuana-legal-states-medical-recreational/4343199. January 6, 2014.
  4. Beal J, Olson R, Shepard KV, Plasse T. Effect of dronabinol on appetite and weight in AIDS: long-term follow-up. Paper presented at: IX International Conference on AIDS; June 6-11, 1993; Berlin, Germany.
  5. Marijuana. National Institute on Drug Abuse website. http://www.drugabuse.gov/drugs-abuse/marijuana. Updated March 2014.
  6. Kumar RN, Chambers WA, Pertwee RG. Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia. 2001;56(1):1059-1068.
  7. Jampel HD. Should you be smoking marijuana to treat your glaucoma? Glaucoma Research Foundation. http://www.glaucoma.org/treatment/should-you-be-smoking-marijuana-to-treat-your-glaucoma-1.php. Updated June 25, 2013.
  8. Gattone PM, Lammert W. Epilepsy Foundation calls for increased medical marijuana access and research. http://www.epilepsy.com/article/2014/2/epilepsy-foundation-calls-increased-medical-marijuana-access-and-research. February 20, 2014.
  9. Himes SK, Scheidweiler KB, Beck O, Gorelick DA, Desrosiers NA, Huestis MA. Cannabinoids in exhaled breath following controlled administration of smoked cannabis. Clin Chem. 2013;59(12):1780-1789.
  10. Marinol [package insert]. http://rxabbvie.com/pdf/marinol_PI.pdf. North Chicago, IL: AbbVie Inc.; 2013.
  11. Marinol cost. Costhelper Health website. http://health.costhelper.com/synthetic-marijuana.html
  12. Medical marijuana cost. Costhelper Health website. http://health.costhelper.com/medical-cannabis.html

All electronic documents accessed January 22, 2016.

From the February 01, 2016 Issue of Clinical Advisor

Topics:

Complementary and Alternative Medicine